Trying to slim down after the birth of her first child, Lucy Hake thought she’d solved a problem familiar to many dieters: how to satisfy cravings for calorific food without sabotaging her weight-loss efforts.
‘I had lost 4st at a slimming club and was feeling good,’ recalls Lucy, 38.
‘But I really missed sugar and the taste of chocolate. I felt restricted on the diet, but didn’t want to gain weight.
‘So I came up with the idea: I could chew the food to get the taste, then spit it out and avoid the calories.’
But far from helping, this was in fact the beginning of a spiral into a distressing battle with food for Lucy – the start of a condition known as chew and spit disorder.
‘I told myself it didn’t count as although I was tasting “bad” food – things like toast with butter and cheese, cakes, chocolate bars – I wasn’t ingesting the calories.
‘So long as I didn’t swallow I reckoned I’d get some of the pleasure and gain none of the weight.’
Lucy Hake, 38, started trying to slim down after the birth of her first child
Dr Elena Touroni, a consultant psychologist and co-founder of The Chelsea Psychology Clinic in London, explains: ‘Chew and spit disorder involves a pattern where individuals chew food but then spit it out before swallowing.
‘It can be a way to cope with feelings of hunger, emotional distress or body image anxiety.
‘Some may feel they have control over their eating or that it helps them manage weight, without the “guilt” of consuming food.’
It’s difficult to know exactly how many people are affected by chew and spit disorder, according to Dr Touroni.
‘It’s often under-reported due to feelings of shame or guilt associated with the behaviour, but it is more common than might be expected,’ she says.
Indeed, researchers behind a 2019 study, published in the journal Eating Disorders, were surprised at their own finding that 12.2 per cent of teenage girls (between 11 and 19) reported regularly chewing and spitting out food – they had expected the behaviour to be much less prevalent.
As well as being psychologically distressing, chew and spit disorder can have physical consequences.
Repeatedly chewing and spitting can lead to dental problems, ‘including enamel erosion, cavities and gum issues due to the constant exposure to food acids and the chewing action, for instance,’ says Dr Touroni.
And, with somewhat painful irony, it can also lead to further weight gain – creating a vicious circle.
Chew and spit disorder may also overlap with eating disorders, such as anorexia (severe calorie restriction) and bulimia (binging and vomiting after eating).
‘It can sometimes be a precursor to anorexia or bulimia, though not always,’ adds Dr Touroni.
However, it is not considered a clinical eating disorder in its own right – it is not currently classified as an eating disorder in the diagnostic ‘Bible’, the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders), the resource used by clinicians and therapists for diagnosing mental health disorders.
This might help explain why people affected find it difficult to get the right support – as has been the case for Lucy.
Dr Elena Touroni, co-founder of The Chelsea Psychology Clinic in London, says chew and spit disorder is often ‘under-reported due to feelings of shame or guilt’
‘I’ve done it for 12 years now – and I can’t stop,’ says the mum-of-two (a boy and a girl, now aged 16 and nine), from the Isle of Sheppey, Kent.
‘My husband, 41, finds it disgusting – and I do, too. When my kids found out they were appalled. I tried to avoid them seeing me do it, but they knew about it.’
Dr Touroni says: ‘Chew and spit disorder tends to be more common in women, particularly in those who have a history of body image concerns or restrictive eating. It can occur at any age, but is most often observed in adolescence and young adulthood, when body image concerns are more pronounced.’
At 5ft 11in, Lucy describes herself as ‘always on the big side’ and on and off diets.
‘After the birth of my first child, when I was 22, I got bigger and reached 22st – so started going to slimming classes.
‘I tried everything, but it was always such a struggle to stick to the boring diets. I missed the “naughty” foods – chocolate and sugar.’
That’s when the idea of chewing – but not actually eating – the foods she craved occurred to her. Then aged 26, she did this once, then twice, then again.
‘I started doing it a few times a week,’ she says. ‘I’d still eat healthy meals and go to weigh-ins at the slimming club, but in between I’d be chewing and spitting a whole bag of Milky Way bars or an entire cake.’
At first, ashamed, Lucy hid her ‘chewing binges’, throwing the bin bags out with the chewed food inside.
But over time, she started to gain weight.
‘I put a stone on, despite otherwise sticking to the diet. I now realise I was ingesting calories during my chewing and spitting, but didn’t know that at the time.
‘This led to a spiral of self-hatred, which led to more chewing and spitting.’
This is not unusual, according to psychotherapist Sally Baker, co-author of 7 Simple Steps To Stop Emotional Eating.
She explains that although people who chew and spit think they are avoiding calories, the brain in fact receives signals the moment food is in the mouth.
The brain gives signals to release several digestive enzymes. The saliva that is swallowed during the chewing process can contain calories.
‘Therefore, weight gain can occur despite spitting out food because small amounts of calories may still be ingested, and the body’s physiological response to tasting food can increase hunger or metabolic changes,’ says Sally Baker.
A year after she’d started, Lucy contacted eating disorder charities, as ‘it just felt time to seek help’.
However, she says, her attempts at getting support drew a blank, with none of the organisations she approached being familiar with her problem.
‘I wasn’t bulimic as couldn’t stand the idea of being sick, nor was I anorexic as I was still eating. I fell somewhere in the middle, but because I was still big I felt I got no sympathy.’
Chew and spit disorder may also overlap with eating disorders, such as anorexia (severe calorie restriction) and bulimia (binging and vomiting after eating)
Yet chew and spit disorder can affect people of all body types, including those who are overweight, at a normal weight, or underweight.
It’s more about the behaviour and the underlying emotional issues than the person’s weight.
‘Chew and spit disorder shares similarities with anorexia and bulimia, especially in terms of preoccupation with food, weight and control,’ says Dr Touroni.
‘It’s a behavioural issue tied to deeper psychological factors such as body image concerns or anxiety. Without proper treatment, the behaviour can persist.’
This means therapy to address underlying emotional or psychological issues.
‘Cognitive behavioural therapy (CBT) is commonly used to challenge unhealthy thought patterns and behaviours,’ explains Dr Touroni.
‘Other treatments may include psychoeducation – which is about teaching someone to understand their condition, why it happens, how it affects them and how to manage it.
‘It helps people recognise unhealthy patterns and find ways to cope – nutrition counselling and developing healthier coping strategies such as mindfulness, exercise, journaling, talking to supportive friends or family, or joining support groups.
‘These alternatives help manage emotions without turning to unhealthy behaviours.’
Sally Baker adds: ‘Chew and spit disorder is often used as a coping mechanism for stress, anxiety, or low self-worth. It provides temporary pleasure or control but is associated with shame, addiction-like behaviours and escapism.’
Yet, she says, chew and spit disorder is less recognisable than other eating disorders.
It’s unsurprising then that Lucy’s family and friends have found it hard to comprehend her behaviour – or know how to help her.
‘My family struggles to understand how I could be so wasteful and not eat the food,’ says Lucy.
‘But it’s a compulsion. If I didn’t have foods I could chew and spit in the house – chocolate bars, cakes – I’d send my husband to the corner shop to get me a bag of chocolate.
‘He’d make me promise I wouldn’t spit it out – but I always did.
‘There is so much guilt as I know it’s a waste of money and also I feel, as a grown woman, I should not be behaving this way and I’m not the best role model for my children.’
The cost has been significant on several levels.
Lucy weighs 22st and is currently trying a low-carb diet. ‘I’ve also had to have fillings totalling £400 because my teeth have rotted due to the chewing and sugar,’ she says.
‘I’ve told my GP and he’s given me anti-ulcer medication because my stomach expects something when I chew and makes acid but then nothing goes down, so I am at risk of stomach ulcers. I get acid reflux at night, too.’
She adds: ‘I know I have to stop, but no one seems to understand how difficult it is. I’m currently looking at other therapies to try so I can one day be free of this.’
